PATIENT INFORMED CONSENT FOR CLINICAL RESEARCH 
Title: A PILOT STUDY OF IMMUNIZATION WITH HLA-A2 MATCHED 
ALLOGENEIC MELANOMA CELLS THAT HAVE BEEN ALTERED 
TO SECRETE INTERLEUKIN-2 IN PATIENTS WITH METASTATIC 
MELANOMA 
Purpose: The purpose of this research study is to evaluate the toxicity and safety of 
these specially altered melanoma cells in patients with metastatic melanoma. 
STATEMENT OF PHYSICIAN OBTAINING INFORMED CONSENT 
I have fully explained this research study to the patient or guardian 
. In my judgment, and the patient’s, there 
was sufficient access to information, including risks and benefits, to make an 
informed decision. 
PHYSICIAN’S SIGNATURE 
PHYSICIAN’S NAME 
(Print) 
DATE 
PATIENT’S STATEMENT 
I have read the description of the clinical research study or have had it translated 
into language I understand. I have also discussed it with the doctor to my 
satisfaction. I understand that 
my patient’s participation is voluntary. I know enough about the purpose, methods, 
risks and benefits of the research study to judge that I (the patient) want to take 
part in it. 
PATIENT NUMBER 
PATIENT SIGNATURE 
Recombinant DNA Research, Volume 15 
[915] 
